Update to Seating Assessment Benefits Available April 1, 2026
AI Summary
Starting April 1, 2026, Texas Medicaid will allow seating assessments (97542) to be billed on the same date as PT/OT evaluations or re-evaluations, but only with distinct start/stop times documented for each service. Claims with overlapping service times will be denied and all same-day claims will undergo manual review.
Action Required
By April 1, 2026: Billing team must update documentation requirements for seating assessments (97542) when billed with PT/OT evaluations. Ensure providers document distinct start and stop times for each service when billing same-day combinations. Update encounter forms and EMR templates to capture separate timing. Failure to document distinct times will result in claim denials.
Affected Billing Codes
Plan Types
Medicaid
States
TX
Specialties
physical-therapy, occupational-therapy, pm-r